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exercise prescribing (counseling)

Procedure: 1) assess current level of fitness a) history b) physical examination c) exercise testing - 2 or more risk factors for coronary artery disease - diabetes mellitus in good control is not a risk factor [4] - hypertension in good control is not a risk factor [4] - symptoms suggestive of coronary artery disease - > 45 years & planning vigorous exercise - for asymptomatic adults at low risk of cardiovascular events, USPSTF recommends against screening with resting ECG or exercise stress test [4,5] - insufficient evidence to assess balance of benefits & harms of screening with resting or exercise ECG to prevent cardiovascular events in asymptomatic adults at intermediate or high risk of cardiovascular events (USPSTF) [5] 2) assess motivation 3) assess barriers a) medical - health conditions - medications - physical disabilities b) social or work-related c) psychologic 4) exercise program a) start with low-intensity physical activity* b) gradually increase exercise intensity c) incorporate warm-up & cool-down sessions* - stretching exercises - before & after exercise - hamstrings, quadriceps, low back & calf muscles d) strength training (6-12 repetitions) twice weekly* e) aerobic exercise - frequency 3-5 days/week - intensity 50-85% of maximum predicted heart rate - duration 15-60 minutes - moderate intensity aerobic exercise at least 30 minutes 5 times/week or vigorous exercise at least 20 minutes 3 time/week [4] f) balance & functional training 5) specific conditions a) low back pain - motor control exercises & graded activity b) type 2 diabetes - structured program of aerobic exercise &/or resistance training c) COPD - pulmonary rehabilitation [3] d) consider risk of falls in the elderly [4] e) osteoporosis - avoid activities that may increase risk of fracture - forward spine flexion, rotation, lifting heavy weights, side bending of the trunk [8] * reduces risk of musculoskeletal injury Notes: - USPSTF concludes evidence insufficient to recommend for or against exercise prescribing - exercise referral schemes increase physical activity & lower incidence of depression, but do not affect BMI, blood pressure, or lipid levels in sedentary primary care patients [2] - combining aerobic exercise with resistance training is most effective for boosting cognitive function in elderly with mild cognitive impairment or dementia [9]

Related

aerobic exercise (endurance exercise)

General

counseling

References

  1. Journal Watch 22(17):137, 2002 US Preventive Services Task Force, Ann Intern Med 137:205, 2002 Eden KB et al, Ann Intern Med 137:208, 2002
  2. Pavey TG et al. Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: Systematic review and meta-analysis. BMJ 2011 Nov 6; 343:d6462 PMID: 22058134 - Williams NH. Promoting physical activity in primary care. BMJ 2011 Nov 6; 343:d6615 PMID: 22058135
  3. Hoffmann TC, Maher CG, Briffa T et al Prescribing exercise interventions for patients with chronic conditions. CMAJ. March 14, 2016 PMID: 26976965 http://www.cmaj.ca/content/early/2016/03/14/cmaj.150684
  4. Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016 - Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  5. US Preventive Services Task Force, Curry SJ, Krist AH et al. Screening for Cardiovascular Disease Risk with Electrocardiography: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;319(22):2308-2314 PMID: 29896632 https://jamanetwork.com/journals/jama/fullarticle/2684613
  6. Izquierdo M, Merchant RA, Morley JE et al International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines. J Nutr Health Aging. 2021;25(7):824-853. PMID: 34409961 Free article. https://www.sciencedirect.com/science/article/pii/S1279770723007881
  7. Riebe D, Franklin BA, Thompson PD et al Updating ACSM's Recommendations for Exercise Preparticipation Health Screening. Med Sci Sports Exerc. 2015 Nov;47(11):2473-9. PMID: 26473759
  8. Camacho PM, Petak SM, Binkley N, et al. American Association of Clinical Endocrinologists/­American College of Endocrinology Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis-2020 Update. Endocr Pract. 2020;26(Suppl 1):1-46. PMID: 32427503 https://www.endocrinepractice.org/article/S1530-891X(20)42827-7/fulltext
  9. Zang W, Fang M, Xiao N et al Exercise prescriptions for older adults with different degrees of cognitive impairment: A dose-response network meta-analysis. Clin Rehabil. 2026 Feb;40(2):154-170. PMID: 41556956